Transformational change does not always happen overnight. In the case of immunization supply chains (iSC), real transformational change requires iteration. It is a process of continuous improvement: cycles of thinking, testing, and improving to constantly push the system forward. While the final result might be a complete redesign of the end-to-end supply chain, each step along the way is a necessary part of getting to a better model. Sometimes the wheels of change move quickly, when political will is aligned with resources and capacity. Sometimes the wheels move more slowly, during phases of learning and refining new ways of doing things. With any large-scale change, the key is to never stop moving forward.
CIDRZ partner, VillageReach recently facilitated an immunization supply chain system design workshop – a first big push towards moving the iSC model forward in Zambia. A week full of dialogue and sharing helped introduce concepts like modeling, build stakeholder buy-in, and “grease the wheels” of inspiration. Participants brainstormed new ideas for both immediate and long-term changes, including a few “crazy” ones. Some of these ideas are already well-defined; others require further development before they could become reality. The pace at which these ideas can be implemented may vary, but the way forward is clear:
- Make Immediate Improvement. Some changes don’t require elaborate planning and complex activities. Simply bringing stakeholders together often results in a list of easy wins – little changes that can impact the immunization supply chain now. In Zambia, helping health workers understand the importance of data, developing maintenance plans for cold chain equipment and delivery vehicles, as well as identifying new opportunities for planning, advocacy, and better coordination will pave the way for longer term improvements. These small changes will bolster support for new ways of working and encourage the conversation to continue long after the workshop ends.
- Build Better Models. With improved data and a stronger understanding of the modeling process, the Ministry of Health, CIDRZ, VillageReach and partners will continue modeling exercises to evaluate new approaches and to figure out what parts of the “crazy” ideas just might work. Modeling allows decision makers to consider a wider range of options without the risk of upsetting the system. In order for modeling activities to provide the best representation of reality, robust datasets are required. Zambia has an excellent start with data from seven provinces – and over the next month, the Ministry of Health and CIDRZ will continue data collection for the remaining provinces. This data will feed back into the system modeling, producing more accurate results from different scenarios.
- Draw the Road Map. With better models utilizing better data, decision makers in Zambia will be well positioned to make informed choices for their immunization supply chain going forward. They will be more prepared to identify obstacles to success and develop new, innovative ways to overcome these challenges. As new questions arise, decision makers will have access to new tools and improved data that will help them find answers, further improving the supply chain.
System design is an ongoing process that makes improvements with every turn of the wheel. Workshops and modeling are only the beginning. These conversations are essential for many reasons: inspiring new ideas and approaches, thinking outside of the box, and bringing together diverse stakeholders to think through obstacles. But the thinking and doing can’t stop there. Zambia has just begun the process of questioning the status quo and rethinking their immunization supply chain. As the wheels of change move forward, Zambia is well on its way to reaching every child with lifesaving vaccines – one step at a time.